Laserfiche WebLink
, . c <br /> i��,� <br /> �� ���5 <br /> Cit of r � <br /> y O ono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �=� Mailing Address: <br /> �'���� POBox66 Permitnumber: a,0lO-'Op :2,$ <br /> f� . �� Crystal Bay, MN 55323-0066 Date received: ..z _� <br /> � <br /> � � �, #n� F� Street Address:' Received by: <br /> � �� 2750 Kelley Parkway Plan review fee: <br /> Lq'kESHO¢� Orono, MN 55356 � <br /> Main: 952-249-4600 Fax: 952-249-4616 Total Fee: ' `10�� � S <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be retumed. (Please print) <br /> GENERAL INFORMATION• <br /> Job Site Address: /�C�Zv��'hn�P�i ,1/,���fl�i2C► i'1/lIJ 5,�,��j, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> /f yes, a special event permit is requrred with Police Department and City Council approval 60 days prior to the evenf. Shuttle bus service wrN be <br /> requfred unless applicant demonstrates su�cient on-site parkin.q is available. Non-permitted evenfs will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ���� <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner <br /> Email and/or Fax: (c�raeo�e� <br /> PROPERTY OWNE .INFORMATION: <br /> Name: " � � l� � � � <br /> Phone(day): ! -2`i� - iF�� l'!;. Lp�2 ' jo- <br /> £�lc 7Yc�,�-'i 5� <br /> Address: ,,. , ,'„ Cit : "' nl� ZIP: � <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal$ <br /> ❑ New Construction Water Supply <br /> ❑Single Family with ❑ Residence <br /> ❑Addition attached garage (�Gara e/Accesso Bld <br /> ccesso Buildin 9 rY 9• ❑ Public Sewer <br /> rY ..9.,.,;-5�'� ` ,i ❑ Single Family with (] Deck <br /> Relocation J�2�;,,�CC detached garage ❑Office/Commercial <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse � Private Sewer <br /> ❑ Public [$Storage .. �¢.�.i�� � Public Water <br /> "*Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) � ther: (Spe ify), <br /> 18202 Minnetonka Blvd ,�,�, . � <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 � �,e,,�,,,' }� <br /> Fax 952-471-0682 C�c `�, �S` _ I <br /> w�wv.minnehahacreek.or J ,��-� JV� <br /> Estimated Construction Valuation (excluding land) $ ��3voo <br /> Last Updated: 9/29/2009 <br /> - 17- <br />